Why don't children take their asthma medications? A qualitative analysis of children's perspectives on adherence.

Focus groups were conducted with children with asthma to generate descriptive data regarding asthma adherence. Transcripts of focus groups were analyzed using qualitative methods. Data collection occurred at an outpatient department of a university-affiliated hospital and at a summer camp for children with asthma. Thirty-six children with asthma ranging in age from 9 years, 1 month to 15 years, 3 months (M age = 11 years, 10 months) participated. Participants provided qualitative descriptions of asthma experiences, including consequences, adherence barriers, and strategies to improve adherence. Researchers also elicited participants' feedback regarding theoretically derived strategies to improve adherence. Children's perceived consequences of asthma included feeling ill, limitations on peer interactions, and medication annoyances. Frequently endorsed barriers to medication adherence were lack of motivation, difficulties remembering, and social barriers. Child-generated strategies to improve adherence included reminders, social strategies, and enhancing accessibility. When children were asked about specific strategies provided by the researchers, motivational strategies (i.e., use of reward as positive reinforcement) were the most highly endorsed. Findings revealed two paradoxes: 1) although children complained that parental reminders are annoying, they also reported that parental prompts help to improve their adherence, and 2) the use of rewards to reinforce adherence was a highly endorsed strategy when presented to children; however, children did not generate this type of strategy on their own.